28 Jobs in Fountain Valley, CA
MemorialCare Medical Foundation is Hiring a Claims Examiner Near Fountain Valley, CA
Claims Examiner
- (MEM008006)
Title: Claims Examiner
Location: Fountain Valley
Department: Claims
Status: Full-Time
Shift: Days (8hrs)
Pay Range: $21.37/hr - $30.97/hr
At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.
Purpose Statement / Position Summary
The Claims Examiner I accurately review, researches and analyzes professional claims. Makes benefit determinations and calculations of type and level of benefit based on established criteria and provider contracts.
Essential Functions and Responsibilities of the Job
- Knowledge of CPT/HCPC and ICD-9/ICD-10 codes and guidelines.
- Comprehensive knowledge of DMHC and CMS guidelines to accurately adjudicate Commercial and Medicare Advantage claims.
- Process HCFA 1500s and COB claims.
- Reviews, processes and adjudicate claims for payment accuracy or denial of payment according to Department’s policy and procedures.
- Processes all claims accurately conforming to quality and production standards and specifications in a timely manner.
- Documents resolution of claims to support claim payment and/or decisions appropriately.
- Makes benefit determinations and calculations of type and level of benefits based on established criteria and provider contracts.
- Understands and interprets health plan Division of Financial Responsibilities and contract verbiage.
- Determines out-of-network and out-of-area services providers and processes in accordance with company and governmental guidelines.
- Adjudication of Commercial and Medicare Advantage claims.
- Ability to prioritize, multitask and manage claims assignment within department goals and regulatory compliance and with minimal supervision.
- Ability to make phone calls to Provider/Billing offices, when necessary, based on department guidelines.
- Requests additional information or follow up with provider for incomplete or unclean claims.
- Ability to effectively communicate with External and Internal teams to resolve claims issues.
Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards
Experience
- Ten keys by touch.
- Type a minimum of 45 words per minute.
- Basic claims processing knowledge.
- Able to recognize CMS 1500 and UB 04 forms.
- Basic knowledge of CPT, ICD-9 codes and ICD-10 codes.
- Understands division of financial responsibility for determination of financial risk.
- Demonstrate effective communication, interpersonal, and organizational skills.
- Excellent written & oral communication skills.
- Ability to follow instructions.
Education
High School Diploma
Job Summary
Full Time
$72k-92k (estimate)
05/20/2024
07/18/2024
The job skills required for Claims Examiner include Claim Processing, Billing, CPT, Communicates Effectively, etc. Having related job skills and expertise will give you an advantage when applying to be a Claims Examiner. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Claims Examiner. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Claims Examiner positions, which can be used as a reference in future career path planning. As a Claims Examiner, it can be promoted into senior positions as a Claims Examiner III that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Claims Examiner. You can explore the career advancement for a Claims Examiner below and select your interested title to get hiring information.
If you are interested in becoming a Claims Examiner, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Claims Examiner for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Claims Examiner job description and responsibilities
Most medical claims examiners deal with paperwork on a daily basis and they are expected to work on multiple claims per day.
04/03/2022: Springfield, MA
Each claim often comes with supporting documents such as medical records and hospital bills and examiners need to look over each file carefully.
03/08/2022: Manchester, NH
Claims examiners are responsible for approving or rejecting claims or arranging settlements.
01/25/2022: Santa Fe, NM
Examiners may review medical bills or accident reports and they may consult specialists.
01/30/2022: Santa Barbara, CA
The Claims Examiner maintains a full case load of professional liability claims.
01/24/2022: Monroe, LA
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Claims Examiner jobs
Keep reading to learn more about a claims examiner role.
03/28/2022: Oklahoma City, OK
Candidates should know that having a critical thinking and outstanding decision-making give examiners the logic and reasoning to evaluate and resolve claims.
04/05/2022: Tulsa, OK
Most employers require or strongly prefer medical claims examiners that have some medical background such as a postsecondary diploma.
03/11/2022: San Antonio, TX
To determine whether a claim should be rewarded, an examiner must be aware of the red flags associated with fraudulent claims and possess detailed analysis skills.
01/30/2022: Bellingham, WA
To begin a career as a medical claims examiner, one must first learn certain knowledge and skills that will help them execute the duties of the job.
02/17/2022: Lawton, OK
Step 3: View the best colleges and universities for Claims Examiner.
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